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General NPI Number Information
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NPI Number | 1861966699
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Entity Type | Individual
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Provider Name | PHILIP HIBNICK MHA, BCIA
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Gender | Male
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Dates
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Enumeration Date | 01/15/2019
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 585 MAIN ST
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City | DUNEDIN
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State | FL
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Zip | 34698-4918
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Country | US
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Telephone | 941-350-9223
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Fax |
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Provider Business Mailing Address
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Address Line | 2840 W BAY DR UNIT 306
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City | BELLEAIR BLUFFS
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State | FL
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Zip | 33770-2620
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Country | US
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Telephone | 941-350-9223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0500X
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Taxonomy Name | EEG Specialist/Technologist
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License Number | E6354
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License Number State |
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